APPLICATION FORM NO.

ENROLLMENT NO.
Non Sponsored

INDIAN MARITIME UNIVERSITY

(A Central University)
East Coast Road, Uthandi, Chennai 600 119

APPLICATION FORM FOR COMMON ENTRANCE TEST

AUGUST 2010

Sponsored

Affix your
Passport size
photograph
(3.5 cm x 4.5 cm)
Duly attested by
the applicant

(Completed form with copies of certificates/ testimonials in case of downloaded applications

along with requisite fee of Rs.800/- / Rs.450/- in case of SC/ST by way of Demand Draft in
favour of the Indian Maritime University, payable at Chennai) should be sent to The Academic
Section, Indian Maritime University, East Coast Road, Uthandi, Chennai 600 119.

COURSE FOR WHICH APPLIED

__________________________________________

1. Name of the Student

:
__________________________________________
(in BLOCK/CAPITAL LETTERS]
(as in the Secondary (10th Class) Examination Certificate)
2. Address for Correspondence
:
[in BLOCK/CAPITAL LETTERS]

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

District

__________________________________________

State

________________________ PIN _____________

3. Fathers (or) Mothers Name

__________________________________________

4. Details of Fees: Demand Draft No:

__________________________________________

Date & Bank Name

__________________________________________

Amount

__________________________________________

5. Telephone No. (if any) with STD code

_________________________________________

Mobile No. (if any)

_________________________________________

E-mail Address (if any)

_________________________________________

6. Date of Birth

__________________________________________

7. Age

Years

Months

Days

(as on date of commencement of Course)

8. Sex

Male

Female

9. Nationality

Indian

Others

10. Territory Code

Urban

Rural

11. Category

Gen.

(If others please specify)

Qualification
10+2

Main Subjects
Physics
Chemistry
Maths
Combined Average

B.Sc. Final Year

3rd year

B.E./B.Tech.

Overall Performance

SC
% of marks

ST

OBC

Name of the Board

/ 100
/ 100
/ 100
%

NOTE:
1. Board / University issuing the 10 + 2 / B.Sc./B.E./B.Tech Degree must be approved /
recognized by Government of India
2. Candidates who do not meet with the pre-requisite criteria regarding PCM percentage of
marks, Marks in English, Age, eye-sight, etc., are advised not to appear for the Entrance Test.
At the time of counseling, when IMU authorities check the certificates regarding prequalification criteria, if it is found that the candidate (s) does not meet the pre-requisite criteria,
though he is qualified in the Common Entrance Test, such candidate(s) will not be given
admission.
13. Name of Sponsoring Shipping Company
(to filled in by Sponsored candidates only)

_________________________________

14. Exam Centre Code No

__________________________________

DECLARATION BY APPLICANT

I hereby declare that I have read and understood the conditions of eligibility for the programme
for which I am seeking admission. I fulfill the minimum eligibility criteria for this programme as
prescribed in the prospectus. I have provided necessary and relevant information. In the event of
any information being found incorrect or misleading, my candidature shall be liable to
cancellation by the University at any time and I shall not be entitled to get refund of any fee paid
by me to the University. Further, I havecarefully studied the rules of the University as printed in
the Prospectus and I accept them and shall not raise any dispute in future over the same rules. I
further declare that I am medically fit as per the standards set by Merchant Shipping Medical
Examination Rules, 2000, as amended from time to time and have also got my eye-sight checked
from a qualified Eye specialist who has certified that I possess 6/6 eye-sight in both eyes and do
not suffer from colour blindness.

Date:
Signature of candidate
--------------------------------------------------------------------------------------------------------------------CHECKLIST:
Before submitting the application form please make sure that you have affixed your photograph
and signed over it and attached the following: (Tick the relevant boxes)
i) Demand Draft for Registration fee for Rs.800/ii) Self-attested Category Certificate for SC/ST/OBC candidates wherever required
iii) 1 No. Self-addressed and stamped to Rs.5/- envelopes [10 x 4-1/2 size].

INDIAN MARITIME UNIVERSITY

( A Central University)
East Coast Road, Uthandi, Chennai 600 119

HALL TICKET

Enrollment No.

Affix your
Passport size
photograph
(3.5 cm x 4.5 cm)
Duly attested by
the applicant

(will be filled by University)

IMU C.E.T.. Date of Exam : 30-05-2010

Time of Exam : 10.00 a.m.- 01.00 p.m.
.Name of the Student : _____________________ (To be filled by IMU) __________________
(to be filled by candidate)
Address: ________________________________ Exam Centre: ________________________
________________________________________ Address: __________________________
________________________________________

___________________________________

___________________ Ph. No.________________

___________________ Ph. No.________

Signature of the Applicant

[IMU authorized signatory]

INDIAN MARITIME UNIVERSITY

( A Central University)
East Coast Road, Uthandi, Chennai 600 119

Enrollment No.
(will be filled by University)

HALL TICKET

Affix your
Passport size
photograph
(3.5 cm x 4.5 cm)
Duly attested by
the applicant

IMU C.E.T. Date of Exam : 30-05-2010

Time of Exam : 10.00 a.m.- 01.00 p.m.
.Name of the Student : _____________________ (To be filled by IMU) __________________
(to be filled by candidate)
Address: ________________________________ Exam Centre: ________________________
________________________________________ Address: __________________________
________________________________________

___________________________________

___________________ Ph. No.________________

___________________ Ph. No.________

Signature of the Applicant

[IMU authorized signatory]

APPLICATION FORM NO.

ENROLLMENT NO.
Non Sponsored

INDIAN MARITIME UNIVERSITY

( A Central University)
East Coast Road, Uthandi, Chennai 600 119

Sponsored

Affix your
Passport size
photograph
(3.5 cm x 4.5 cm)
Duly attested by

ADMISSION FOR COUNSELLING

AUGUST 2010 BATCH

PROFORMA
1. Enrollment No.

__________________________________________

2. Rank

__________________________________________

3. Name of Institute / College opted 1. :__________________________________________

2. :__________________________________________
3. :__________________________________________
4. Details of registration Fee Amount Rs.10, 000/- D.D. No.
Name of Bank

Branch

Dated

1. Name of the Candidate:

________________________________________________

2. Fathers (or) Mothers Name:

________________________________________________

3. Date of Birth :

________________________________________________

4. Address for Correspondence:

_______________________________________________

Phone No:

________________________________________________

ALL APPLICATIONS SHOULD BE FILLED IN ONLY IN ENGLISH

5. Category:

Gen

SC

ST

OBC

6. Relevant Educational Qualification (which make you eligible for the programme)
Sl.
No.

Qualification Subjects

Board/University

Grading %
of Marks

CERTIFICATE
I _____________________________________hereby certify that the above information
furnished by me is correct in all respects. I understand that any misrepresentation or omission of
facts in this application may justify denial or cancellation of admission from the above course. I
agree that the registration fees for counseling once paid shall not be refunded under any
circumstances.

Date:

Signature of the Candidate:

Place:
Enclosures:
Demand Draft!
Copy of Date of Birth Certificate
Copy of educational certificates
Copy of Community Certificate.
NOTE: Candidates are required to bring all the Original Certificates for verification.
--------------------------------------------------------------------------------------------------------------------Certified that the details are verified and found correct.

Seal

For Indian Maritime University.